1497845101 NPI number — EXETER EMERGENCY PHYSICIANS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497845101 NPI number — EXETER EMERGENCY PHYSICIANS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXETER EMERGENCY PHYSICIANS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497845101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 ALUMNI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03833-2128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-580-6793
Provider Business Mailing Address Fax Number:
603-580-7006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 ALUMNI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXETER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03833-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-580-6793
Provider Business Practice Location Address Fax Number:
603-580-7006
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/MEDICAL DIRECTOR
Authorized Official Telephone Number:
603-580-6793

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28317 . This is a "BMC HEALTHNET PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 689149 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101073100 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30211012 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9703811 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH5646 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 142840000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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